France overview

Thirty years after the opening of the first DCR in Switzerland, France has become the 10th country to open a drug consumption room, on the 17 of October 2016. The first one has opened in Paris and is handled by the health and social structure Gaïa-Paris, a second one has opened November 7th in Strasbourg, handled by Ithaque association. Both DCR are located in public hospitals, even though they have a separate entrance and are only administered by the health and social structures in charge.

Harm reduction approaches in France have been developed by civil society organizations since the late 80’s and the HIV epidemic. In 1987, clean needles could be bought from pharmacies and two years after, Médecins du Monde France was starting the first free and anonymous needle exchange program. It was later institutionalized by the 2004 public health law that allowed for the creation of CAARUD (low threshold centers that promote harm reduction, welcome and help drug users with social and health aspects). Since 1994, France has also allowed the controlled prescription of opioid substitution treatments such as methadone and buprenorphine, which can be delivered by health centers of prevention in addictology, called CSAPA, also institutionalized by the 2004 law.

In January 2016, a new public health law was adopted and its article 43 allows the experimentation for 6 years of drug consumption rooms, in cities that apply for it.

In the northeast of Paris, next to one of the busiest train station in Europe, is located the main open drug scene of the region. PWUD inject mostly sulfate morphine and smoke crack cocaine in parking lots, building entrances, public restrooms or on sidewalks. In France, 10% of PWUD are infected by HIV and over 40% have contracted Hepatitis C. In 2009, in response to this public health crisis, harm reduction civil society organizations came together and installed a mock DCR to attract public and political attention, which was successful.

In 2012, after a proposal submitted by Gaïa-Paris and Médecins du Monde France, the mayor of the 10th district, Rémi Féraud, declared himself in favor of opening a DCR in his district. The government agreed to work on the project in 2013 but the Council of State stopped the process when they declared that the current law was not adapted to protect the establishment of the DCR. The new public health law of January 2016 allows the experimentation of DCRs but foremost protects the staff from penal offenses under the 1970 illicit substances law, and tolerates the consumption of illicit products in the DCR.

There are two main objectives, one of public health and the other one of public safety, that is:

Reduce the risks of lethal overdoses, the transmission of infectious diseases such as HIV and Hepatitis C, and other complications by providing a safe and clean environment and material, and supervising the consumption;

Orientate those who wish towards substitution treatments, or weaning;

Give access to the health and social system to marginalized PWUD;

Create and reinforce social links with PWUD;

Reduce the rate of drug use in public spaces and the presence of discarded needles and used materials.

INSERM, the national public institute of medical research and public health is in charge of carrying out a scientific and sociological evaluation of the DCR in France :

One aspect of the evaluation is to study the impact of the DCR on criteria such as the reduction of at-risk practices, improvement of mental health, social insertion, improvement of access to health and social services, impact on crime rates…

The other part of the evaluation is dedicated to the social acceptability of the DCR among PWUD, inhabitants of the neighborhood, health care professionals, public safety professionals… this part will be carried out in Paris, Strasbourg, Bordeaux (where a DCR might open soon), and Marseille (no DCR).

The final results of the evaluation will be delivered to the French Parliament 6 months before the end of the experimentation and will be determinant for the future of DCRs in France.

The team in Paris is composed of GPs, nurses, social workers and security agents. Peer workers will also join the team, and will be staffing the welcoming area and the resting area. Their inclusion and participation to the functioning of the DCR is essential for Gaia. The DCR is opened 7/7, from 1:30 PM to 8:30 PM.

News

DCR involvement in HCV prevention and treatment is crucial. So what is their response and where are the needs?Uniting, Sydney and INDCR/Correlation Network published new report.

The report - based on an online survey under DCRs/SIFs worldwide - describes the range of services currently offered, the existing approaches to HCV awareness, prevention and treatment and what the needs are to improve and extend services.

The Sydney based Uniting Medically Supervised Injection Centre prepared an exhaustive, easy to read overview of scientific & grey literature that would facilitate scholars and advocates working in this area:

The document includes evidence of SIF/DCR effectiveness in regard of attracting high risk drug users, managing overdose and decrease overdose-related mortality, enhancing safe injecting practice, decreasing public drug use and improve public amenity and more.